Jarett D. Berry

Background: Prior prediction equations for heart failure (HF) omitted cardiac biomarkers and used select populations. We assessed the added value of NT‐proBNP (NT‐terminal pro‐brain natriuretic peptide) and hsTnT (high‐sensitivity troponin T) as predictors of HF, across a broad population, including participants with chronic kidney disease or atherosclerotic cardiovascular disease. Methods: Among 41 427 individuals free of HF from 9 prospective cohort studies, we performed an individual‐participant data meta‐analysis, quantifying the associations of NT‐proBNP and hsTnT with incident HF when added to a clinical model. Changes in Harrel’s C‐statistic with and without NT‐proBNP or hsTnT were estimated within each cohort and then pooled using random effects meta‐analysis. Results: Over a mean of 11 years, 4599 incident HFs occurred. A 2‐fold higher NT‐proBNP was associated with incident HF (meta‐analyzed hazard ratio [HR], 1.47 [95% CI, 1.38–1.56]), P P= 0.33) or atherosclerotic cardiovascular disease (HR, 0.97 [95% CI, 0.93–1.02], P =0.48). Adding NT‐proBNP significantly increased the C‐statistic by 0.030 (95% CI, 0.021–0.040, P P P P <0.001). Conclusions: NT‐proBNP improved risk discrimination of incident HF when added to traditional HF risk factors, even in individuals with chronic kidney disease and atherosclerotic cardiovascular disease. The contribution of hsTnT was modest. Measurement of NT‐proBNP may help identify individuals at risk of HF.

Background: Hypertension is a major risk factor for cardiovascular disease (CVD). The SPRINT (Systolic Blood Pressure Intervention Trial) study demonstrated that intensive lowering of systolic blood pressure (SBP) targeting P interaction=0.01). Among Black participants, the association of SBP lowering with the composite end point did not differ significantly by education. Conclusions: Despite similar SBP, higher education was associated with a larger improvement in cardiovascular outcomes following intensive SBP reduction, with differences by race. These findings highlight the relevance of social factors such as education in the generalizability of clinical trials.

Background: Cross‐sectional studies suggesting that SARS‐CoV‐2 infection and long COVID are associated with reduced cardiorespiratory fitness (CRF) lack preinfection CRF measures. The objective of this study was to determine the association of SARS‐CoV‐2 infection and long COVID with change in CRF. Methods: Cooper Center Longitudinal Study is a cohort study based at the Cooper Clinic, a preventive medicine clinic in Dallas, Texas; we included adults ages 20 to 74 years old with CRF assessed at least twice between 2017 and 2023. COVID status was defined as “prepandemic” (2 CRF measures pre‐2020), “uninfected” (no self‐reported COVID), “recovered” (self‐reported COVID with symptoms ≤3 months), or “long COVID” (self‐reported COVID with symptoms >3 months). CRF was estimated in metabolic equivalents via a maximal modified Balke treadmill protocol. Results: We included 4005 participants (mean age: 51.8 years, 26.8% women), of whom, 1666 (41.6%) reported COVID and 80 (4.8% of infected) reported long COVID along with 1826 uninfected and 513 pre‐pandemic controls. At baseline, those who later developed long COVID had lower CRF (10.0 metabolic equivalents, 11.1 recovered, 10.7 uninfected, 11.3 prepandemic; P P P =0.02) but not by long COVID status ( P =0.10). Conclusions: Pre‐COVID fitness, on average, is lower among people who developed long COVID. COVID does not greatly accelerate age‐related declines in CRF, even among some with long COVID, although few included participants had severely disabling long COVID. Future longitudinal research will clarify if differences in CRF by infection status emerge over longer follow‐up.

BACKGROUND: High-volume physical activity (PA) is associated with a higher prevalence of subclinical coronary artery disease (CAD). However, the clinical significance of subclinical CAD among high-volume exercisers remains incompletely understood, and the dose–response relationship between high-volume PA and clinical CAD events remains uncertain. METHODS: Individual participant data from the Cooper Center Longitudinal Study (1987–2018) were linked to Medicare claims files. PA volume was determined by self-report and categorized as P P _interaction = 0.969). CONCLUSIONS: Compared with low-volume PA, high-volume PA was associated with a lower risk for all-cause mortality but a similar risk for clinical CAD. CAC was associated with an increased risk for clinical CAD regardless of the volume of PA.

Precision medicine aims to provide personalized clinical care guided by tools that reflect underlying pathophysiology. The need for such an approach has never been greater in cardiovascular medicine, given the large number of guideline-directed medical therapies available. However, progress has been modest to date with few precision tools available for clinicians. Arguably, cardiovascular prevention and population health are poised for innovation to guide evaluation and management, as these areas are already informed by risk-assessment, but limited by the use of crude assessment tools with marginal performance. Risk assessment in prevention and population health may be improved with the use of genetics, circulating biomarkers, and imaging, leading to outcome-specific risk-prediction and enhanced phenotyping. Personalized management matching therapy to risk profile can be then implemented for either individuals or groups, improving cost-effectiveness and risk-benefit. Here, we explore this precision-like approach, including available tools, potential applications, and future perspectives for cardiovascular prevention and population health management.

Background: Prematurely born adults have increased risk for cardiovascular disease. There are limited cardiac data on US‐born preterm individuals. We aimed to determine whether adolescents and adults born prematurely have altered left ventricular (LV) structure and function, and to interrogate diastolic function using isometric handgrip exercise. Methods and Results: Adolescents and adults born moderately to extremely preterm (≤32 weeks gestation or P 2 , P 2 , P 2 , P =0.002) compared with term individuals. Preterm participants also had subclinical reductions in LV peak systolic tissue velocity and peak early diastolic tissue velocity lateral at rest. Isometric handgrip exercise promoted a reduction in diastolic function and an increase in hemodynamic measures, but changes during isometric handgrip exercise were similar between groups. Conclusions: Adolescents and adults born preterm exhibit overall normal cardiac function despite smaller cardiac volumes and mass compared with individuals born full term. Effects are most pronounced at the lowest gestational ages.

BACKGROUND: Hs-cTnT (cardiac troponin T measured with a highly sensitive assay) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) may identify adults with hypertension who derive greater cognitive benefits from lower systolic blood pressure targets. METHODS: In the SPRINT (Systolic Blood Pressure Intervention Trial) MIND study, participants were categorized as having both hs-cTnT and NT-proBNP in the lower 2 tertiles (n=4226), one in the highest tertile (n=2379), and both in the highest tertile (n=1506). We assessed the effect of intensive versus standard treatment on the composite of mild cognitive impairment (MCI) or probable dementia (PD) across biomarker categories. RESULTS: Over a median follow-up of 5.1 years, 830 of 8111 participants (10.2%) developed MCI or PD. Participants in the highest biomarker category were at higher risk of MCI or PD compared with those in the lowest category (hazard ratio, 1.34 [95% CI, 1.00–1.56]). The effect of intensive treatment on reducing the risk of MCI or PD was greater among participants in the lowest biomarker category (hazard ratio, 0.64 [95% CI, 0.50–0.81]) than those in the intermediate (hazard ratio, 1.01 [95% CI, 0.80–1.28]) or highest categories (hazard ratio, 0.90 [95% CI, 0.72–1.13]; P _interaction =0.02). The 5-year absolute risk differences in MCI or PD with intensive treatment were −2.9% (−4.4%, −1.3%), −0.2% (−3.0%, 2.6%), and −1.9% (−6.2%, 2.4%) in the lowest, intermediate, and highest biomarker categories, respectively. CONCLUSIONS: In SPRINT, the relative effect of intensive systolic blood pressure lowering on preventing cognitive impairment appears to be stronger among participants with lower compared with higher cardiac biomarker levels, though the absolute risk reductions were similar.